NPIMap

Organization Active NPI

Chung Kim DDS, Inc

  • Dentist
  • Perris, CA
National Provider Identifier
1376750307
Registry record updated Apr 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
23935 Issued in CA
Legal business name
CHUNG KIM DDS, INC
Practice address
180 E 4TH St
Suite a
Perris, CA 92570-2125
Phone
(951) 657-3102
Fax
(951) 657-7783
NPI assigned
May 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Chung Kim, DDS
Title
President
Phone
(951) 657-3102

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 23935 CA Primary

Addresses

Primary practice location

180 E 4TH St
Suite a
Perris, CA 92570-2125

Mailing address

180 E 4TH St
Suite a
Perris, CA 92570-2125
Phone (951) 657-3102

Other identifiers 1

IdentifierTypeStateIssuer
23935-01OtherCAMEDICAL

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366156800000",
    "number": "1376750307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 E 4TH ST",
            "address_2": "SUITE A",
            "city": "PERRIS",
            "state": "CA",
            "postal_code": "925702125",
            "telephone_number": "951-657-3102",
            "fax_number": "951-657-7783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 E 4TH ST",
            "address_2": "SUITE A",
            "city": "PERRIS",
            "state": "CA",
            "postal_code": "925702125",
            "telephone_number": "951-657-3102",
            "fax_number": "951-657-7783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHUNG KIM DDS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-17",
        "last_updated": "2013-04-17",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "CHUNG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "951-657-3102",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "23935",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL",
            "identifier": "23935-01",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Perris, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.